At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones). When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com﻿

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind.

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

You are patiently explaining to the third doctor that the bruising on your arm is a sure sign of leukemia. Once again, she tells you that the tests all came back negative. You’ve heard it all before. She explains that much like the parasites causing intense stomach pain were just some gas, and the terrible headache in June was not a brain tumor but most likely a sign of dehydration, this is just a normal bruise and should clear up in a few days. You attempt to cap your seething frustration as you push your doctor to try another test. As soon as you get home you make an appointment with another doctor - perhaps this one will help. Welcome to the challenging world of someone coping with Hypochondriasis, sometimes referred to as Health Anxiety or Illness Anxiety.

Hypochondriasis, estimated to be affecting 1-7% of the population, causes a person to dread that she has, or is going to have, a terrible disease or physical ailment. This person may constantly monitor her vital signs, and see minor changes in her body as “symptoms” of something far more ominous. She may “hop” from doctor to doctor, reading obsessively online about disease and seeking validation and treatment by demanding unneeded tests. Negative tests may bring some temporary reassurance, but this typically wears off quickly, only to be replaced by more illness fears.

Those suffering from Hypochondriasis may believe that their excessive worrying is protecting them. They may believe that any discomfort or imperfection of body functioning is a sign of serious illness. Perhaps they sense that any doubt or uncertainty demands thorough investigation. Often they may scour the Internet until they find “proof” that the symptom they are concerned about is associated with a debilitating or deadly disease, such as cancer.

While hypochondriasis might seem funny or eccentric at first, those who have had or known someone with hypochondriasis tell a different story. The obsessive check-ups, monitoring, research, and fear can demand an enormous time investment and stress academic, professional and social relationships to the breaking point. Hypochondriasis can cause a person to become so obsessive that it appears to share similarities with Obsessive Compulsive Disorder (OCD). In particular both diseases share the feature that the more an individual attempts to address their fears (by checking, washing, doctor hopping, etc.), the more intense those fears tend to become. An important difference that distinguishes the two is that while someone with OCD may live in terror of getting a disease, someone with Hypochondriasis lives with the fear that they already have it.

Recommendations to those with Hypochondriasis include sticking to one doctor, avoiding Internet searches about illnesses, keeping active, and stopping self-checks. Of course making these changes is often very difficult to do without help, especially because the very nature of Hypochondriasis is the lurking sense that diagnosis of disease is just one doctor away. The nightly news often offers headlines that read as confirmation of a new health threat and a bombardment of well-meaning public health messages could leave anyone on high alert. However, WebMD is not the answer so where else can someone turn who is struggling with hypochondriasis?

The first step is education about the condition. Understanding hypochondriasis is crucial to gaining the power to change and sticking with a treatment plan. Make sure that a licensed or supervised psychologist is part of the healthcare team. Not only do they have the expertise to diagnose Hypochondriasis, but research has equipped them to to treat it. Due to the many similarities between OCD and Hypochondriasis, strategies developed to treat OCD have been found to be highly effective when adapted to the treatment of Hypochondriasis. According to recent studies by Harvard University and the Mayo Clinic, the most effective treatment is Cognitive Behavioral Therapy (CBT).

CBT is designed to help identify and change the behaviors that maintain and worsen anxiety and other symptoms of hypochondriasis. Sometimes it may include exposure therapy-- confronting fears little by little until they lose their power. For example, if someone is terrified that they have cancer, they may visit a cancer hospital. Another technique, cognitive restructuring, teaches clients to challenge the validity of their health related fears. An approach that borrows from Mindfulness-Based CBT, is to learn non-judgmental acceptance of unpleasant thoughts. From a mindfulness perspective this discomfort is normal, and distress arises from the persistent attempts to control or escape discomfort.

Over the course of therapy, which is often as short as 16-20 sessions, clients learn to use these tools to challenge their health related anxiety as well as the behaviors that they have been using to cope with those fears. If you would like more information on Hypochondriasis or Cognitive Behavioral Therapy, click here to contact us.

References:

Leahy, Robert L. “Are You a Hypochondriac?” Retrieved October 9th 2013 from:

In our last blog, we discussed what suicide is and the high rates of suicide impacting many of us nationwide. Now it is time to talk about solutions. If you or someone you care about is thinking about suicide, stop and think for a moment about who you could go to for help. Regardless of your age, think about who the trusted adults and friends are in your life. It isn't an easy conversation to have, so if you or someone you know is struggling, it can be really helpful to have a caring person in your corner. If a person is in need, she may be working hard to hide how she feels, but hoping desperately that someone notices how much she is hurting. If you need someone to talk to and you don't have the words to ask, start with “I need help”.

If someone comes to you for help, the first thing you should do is stay with the person in need. Don’t leave her alone. Unless there is a threat of harm to you, stay with her even if it’s just on the phone. Even if you’re going to be late for work, or school, or dinner at Mom's, stay with her, others will understand..

Next, listen; really listen. There is an old saying that we were given 2 ears and 1 mouth so we could listen twice as much as we speak. This is too important to make a joke or dismiss the person’s concerns. Be supportive. There are some tough questions you can ask that will show you care. “Are you ok? Are you thinking of hurting yourself? Will you go with me to get help? Who would you like to talk to?” These questions are about getting the help needed to survive this crisis.

The most important thing you can do is to get help. Chances are, you aren’t a trained counselor. Getting help is essential because this isn’t a simple situation you can handle on your own. Even though I’ve received training in crisis counseling and suicide assessment, the first thing I do with a person in crisis is to notify my supervisor for backup. It’s always OK to ask for help. It is ALWAYS OK to ask for help. This problem is bigger than one person, so ask “Are you getting help? Can I help you get help?” There are two numbers that you can use to get help. 1-888-724-7240 is a local San Diego crisis line available 24-7. The other number is a national number you can use if the crisis is out of the area and that is 1-800-273-TALK. These numbers are both nation-wide and toll free 24-7. You can call and speak to a professional for immediate help. Also, don’t be afraid to call 911. This is an emergency.

Your friend may ask you to keep what he’s told you a secret. Don’t do it. This is too important. You are not a friend if you’re letting the person you care about keep all that pain to himself instead of getting help. This secret is not worth dying for.

How do we know if someone needs help? The major warning signs are actually pretty obvious. If you hear someone is threatening to kill himself, looking for ways to kill himself, or talking or writing about suicide or death you need to find help immediately. We can’t afford to ignore statements like “I wish I was dead. I never should have been born. You would be better off without me.” These are cries for help. A person who is contemplating suicide may feel hopeless, angry, or vengeful, and act recklessly without thinking. If something seems wrong and you are worried, get help immediately. For someone in a suicidal crisis, help can’t wait. What happens if your friend was just being dramatic and you called 911? He might be pretty embarrassed, he might have some explaining to do. What if he wasn’t being dramatic? Boom. Embarrassment just became the best-case scenario. Better to lose a friendship than to lose a friend.

Pay attention if your friend suddenly starts using more drugs and alcohol. 50% of those that attempt suicide are under the influence, most frequently alcohol. People who feel suicidal might seem moody, anxious, agitated or sleep all the time or not at all. Often, suicidal people give away their favorite things to their favorite people, or stop participating in their favorite sports and activities. Adults may pay off all the bills or update their will. If a teen quits the team or tries to give away her iPod, surfboard, Xbox, or favorite boots to her best friends, she might be saying goodbye. This is a big one because the adults in a teen's life probably won’t know about it if friends don’t speak up. If someone suddenly doesn’t want to hang out with her friends or avoids talking to her family, she may be withdrawing in preparation for life to end. This is when your friend needs you the most. Take her out to do something she might enjoy, or if she won’t go out, then go to her. Don’t put it off. Spending time with someone who cares is especially important because people who are depressed or suicidal often feel an intense sense of loneliness and worthlessness.

In addition to warning signs, we can also look at risk factors. Breakups, divorces, major life transitions like changing schools, jobs, or moving away from friends, trauma or loss such as death of loved ones, abuse, or bullying are all potential risk factors for depression or suicide. If you or someone you know is being abused, tell a trusted friend or adult. Nobody should have to put up with physical, sexual, or emotional abuse. These days bullies are on Facebook, in school hallways, at work, and even texting on your cellphone, and it's hard to get away. Many adults and teens don't know that lesbian, gay, bi-sexual, transgender and questioning youth are 4x more likely to attempt suicide than their heterosexual peers because of the way they are treated in their homes, schools, communities, and religious institutions. If you see someone who can’t stand up for himself then stand up for him. We don’t have to tolerate hate. No one should suffer alone.

We’ve got to take care of ourselves too. Everyone feels overwhelmed sometimes, but there are some really simple things we can do to cope. Two of the best things we can do are exercise and eat healthfully. In fact, since the early 1980's, research has shown that regular exercise may be as effective as antidepressant medication for combating depression. Also I highly recommend dark chocolate. Very helpful tool, boosts serotonin, a happy chemical in your brain. Add it to the grocery list. Laughter and keeping your sense of humor is another way to cope. Keeping busy with activities or working with others as a volunteer to make a difference in your community is a great way to feel good about your life. These are good supplements to professional treatment and are good coping strategies even for people who aren’t feeling depressed to decrease overall stress.

If you would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077 or csamsandiego@gmail.com. To see a list of other mental health conditions that we specialize in, click here.

The week starting September 8th is National Suicide Prevention Week. Did you know we are losing 34,000 Americans every year to suicide? 5,000 of these are teenagers. For every one completed suicide there are 100-200 attempts. If you do the math, that’s 5000 x 100 or 200 = between 500,000 and a million suicide attempts every year by people between 14 and 24 years of age. That’s a big, big, deal especially because we have learned that if someone has attempted suicide once, they are at a much higher risk to attempt it again.

Did you know that suicide is rising faster in youth between 10 and 14 than in any other age group? What grade are you in when you’re 10 years old? 5th right? Some of us probably have family, friends, or neighbors that age. Did you know that suicide is the #2 cause of death for college aged Americans? Right here in San Diego, on average, we lose one teen between 15 and 19 years old to suicide every month. We’re losing children, friends, nieces, nephews, cousins, brothers and sisters to suicide every day, and sometime in your life suicide may affect you or someone you know.

There is a myth about suicide that if you talk about it someone will attempt it. Does that make sense to you?

Of course not.

People that attempt suicide are in pain. They feel alone and they feel that they have no other way out. They need to talk! Some people think that when someone decides to attempt suicide there is nothing you can do to stop them. Well everyone has good days and bad days right? Suicidal feelings are usually temporary, but suicide is permanent. These people have usually had a lot of bad days in a row, and that is called depression, and they need help. As much as 90% of suicides are the result of an undiagnosed mental illness, mostly depression. That is awesome news, because although we can’t see depression, , we can treat it. Suicide can be prevented. Depression treatment has a very high success rate. Medication can be helpful and therapy can teach those suffering from depression methods for getting healthy and feeling good. I’ll tell you more about that later. For now, I want you to remember that you may not be able to help getting depressed, but you can help yourself get help.

If you are concerned that you or someone you know might be thinking about suicide get help! In an emergency, call 911. For information and support there are two numbers that you can use to get help. These numbers are both nation-wide and toll free 24-7. 1-888-724-7240 is a local San Diego crisis line. The other number is a national number you can use if the crisis is out of the area, that is 1-800-273-TALK.

Over the next few weeks, this blog will be sharing a story about the author's personal encounter with suicide and sharing tips for how to recognize and prevent suicidal behavior. The first step toward preventing suicide is to start conversations and take away the stigma that isolates people with suicidal thoughts. Please check back to learn more and share these blogs with the people you care about.

If you are suffering from anxiety or depression, don't wait until it becomes a crisis.

If you would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077 or csamsandiego@gmail.com. To see a list of other mental health conditions that we specialize in, click here.

If you are interested in spreading awareness on how to prevent suicide in San Diego you can learn more from Yellow Ribbon of San Diego.

Last week I shared a little bit about my experience working with San Diego’s veterans at Stand Down. This week I will address the questions and misconceptions that come up for many people in any conversation about Post-Traumatic Stress Disorder.

It has had many names, some going back as far as the American Civil War: shell shock, combat fatigue, soldier’s heart, combat neurosis, and, most recently, Post Traumatic Stress Disorder (PTSD). Some experts predict that as many as 30% of Iraq and Afghanistan combat veterans will receive treatment for PTSD. What was first observed as changes in soldiers that had survived combat is now recognized in many people who have witnessed, experienced, or even been affected by any of a variety of traumatic experiences.

It is becoming increasingly common, affecting as many as 3.5 out of every 100 US residents according to the National Institute of Mental Health. Symptoms may include nightmares, flashbacks, uncontrollable thoughts about the traumatic event and severe anxiety. These experiences, along with very disruptive physiological effects related to anxiety, can persist for weeks, months, or years.

Most Americans are familiar with PTSD; it has been featured in major motion pictures from The Deer Hunter to Forrest Gump. Unfortunately, as with many complex subjects that receive the pop-culture treatment, PTSD is sometimes portrayed in a confusing and even irresponsible manner. Because of the widespread misunderstanding about PTSD and veterans who have been through combat, this week we will take a moment to address a few myths you may have heard.

MYTH: Everyone has been through a frightening experience that resulted in symptoms like PTSD. Eventually people get over it.

Fact: Frightening experiences may create vivid memories, however most people do not suffer the impairment and severity of symptoms characteristic of PTSD. Although there are many similarities between PTSD and other forms of anxiety, PTSD is unique in its effects on the brain's responses to events. PTSD can sometimes cause serious disability. It is a medical disorder than sometimes becomes complicated by co-occurring anxiety, mood, and substance-abuse disorders. It may cause significant problems in social interactions, relationships and ability to work.

MYTH: PTSD is a sign of “weakness” and “lack of character” in people who are unable to cope with difficult situations in the same way most people do.

Fact: For many people who have been exposed to markedly abnormal situations PTSD is a normal reaction. A person experiencing a traumatic event undergoes chemical changes in the brain in order to survive and function through his or her experience and these create symptoms that we recognize as PTSD. PTSD is not a result of moral failing or a weak character. Some studies suggest that half of all Americans will meet the criteria for a mental health diagnosis at some time in their lives.

MYTH: PTSD causes people to become violent and unpredictable.

Fact: Many people believe that mental health problems are associated with violence and unpredictability but this is rarely true. Someone with PTSD or another psychological condition should not be viewed as dangerous in the home or workplace. These fears result in stigmatizing diagnosis and treatment for people that need and deserve our respect, acceptance and help. PTSD and other psychological conditions only very rarely result in acts of aggression.

MYTH: Once you've been diagnosed with PTSD you will never recover. Therapy is a waste of time.

Fact: New studies are emerging all the time that show that most people with PTSD and other mental illnesses do get better and make full recoveries. Recovery may mean reduced symptoms and or the ability to lead a productive and fulfilling life. Many people recover their ability to live, work, learn, and participate in their communities. Some combination of therapy and medication plays a role in many recoveries and science has shown that hope and positive social support are two of the most important factors in predicting success.

MYTH: People with PTSD can't handle the everyday stress of finding and keeping a job.

Fact: If jobs weren't difficult and stressful we wouldn't pay people to do them. As with any other psychological condition, the severity of PTSD and an individual's path to recovery can vary widely. Balancing stress and stress tolerance well by matching employees’ needs to their work conditions leads to productivity and success. Studies show that most people with PTSD and other mental illnesses demonstrate motivation, punctuality, quality work, high attendance, and job tenure. Any employer can improve their gauge of workload and performance by considering these factors.

If you or someone you care about is struggling with PTSD or heightened anxiety as a result of serving in combat or another traumatic experience, and would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077or csamsandiego@gmail.com